BMC Hea/th SeTVices Research 2016, Volume 16 Suppl 3 DOI10.1186/s129n"-<l16-1423-5 BMC Health Services Research

Proceedings of the 3rd IPLeiria's International Health Congress Leiria, Portugal. 6-7 May 2016

Published: 6 Ju!y 2016

Session 1: Citizenship in health

S1 Health literacy and health education in adolescence Catarina Cardoso Tomás Health Sciences Research Unit: Nursing, Collegue of College of Health Technology of Coimbra, Coimbra, Portugal BMC Hea/th Services Research 2016, 16(SuppI3}:S1

Health literacy, a more complex concept than knowledge, is a re­quired capacity to obtain, understand, integrate and act on health in­formation [1], in order to enhance individual and community health, whlch ls defined by different leveis, according to the autonomy and personal capacitation in decision making [2]. Medium leveis of Health literacy in an adolescent population were found in a study conducted in 2013/2014, being higher in sexual and reproductive health and lower in substance use. It was also no­tlced that the higher leveis of health literacy were in the area ado­lescents refer to have receipt more health information. lhe health IIteracy competence with higher scores was communication skills, and the lower scores were in the capacity to analyze factors that in­fluence health. Higher leveis were also found in younger teenagers, but in a higher school levei, confirming the importance of health education in these age and development stage. Adolescents seek more Information in health professlonals and parents, being friends more valued as a source information in older adolescents, which enhance the importance of peer education mainly in older adoles­cents [31. As a set of competences based on knowledge, health literacy should be developed through education interventions, encom­passlng the cultural and social context of individuais, since the society, culture and educatlon system where the individuai is inserted can define the way the development and enforcement of the health literacy competences [4]. lhe valued sources of infor­mation should be taken into aeeount, as well as needs of informa­tion in some topics referred by adolescents in an efficient health education.

References 1. Borzekowski D. Considering Ch ildren and Health Literacy: A Theoretica l

Approach. Ped!atrics. 2009; 124: 5282-5288. 2. Nutbeam D. The evolving concept of health literacy. Soc Sei Med. 2008;

67: 2072-2078. 3. Tomás C. Literaeia em 5aúde na Adolescência [Doctaral Thesisl.

OPorto: Abel 5a lazar Institute of Biomedical 5ciences of Oporto University; 2014.

4. Committee on Health Literacy. Health Literacy: A Prescription To End Confusion. Washington, D. c.: The National Academies Press. 2004.

Session 2: Evaluation & intervention in health S2 lhe eftect of a walklng program on the quality of life and well­belng of people wIth schizophrenla Emanuel Oliveira ' .2, D. Sousa ', M. Uba-ChupeI2

, G. Furtado2, C. Rocha3

,

A. Teixeira2, P. Ferreira 2

'Sisters Hospitallers of the Sacred Heart of Jesus, Casa de Saúde Rainha Santa Isabel, Coimbra, Portugal; LResearch Unit for Sport and Physical Activity, Faculty of Sport Sciences and Physical Educatlon, University of Coimbra, Coimbra, Portugal; 3Compiementary Science5- INESCC, Coimbra, Portugal Correspondence: Emanuel Oliveira - Slsters Hospitallers of the Sacred Heart of Jesus, Casa de Saúde Rainha Santa Isabel, Coimbra, Portugal BMC Heafth Services Research 2016, 16(Suppl 3};S2

Schizophrenia is a serious and chronic mental illness which has a pro­found effect on the health and well-belng related wlth the well-known nature of psychotic symptoms. The exercise has the potentlal to im­prove the life of people with sehizophrenia improving physical health and alleviating psychiatric symptoms. However, most people with schizophrenia remains sedentary and lack of aceess to exereise pro­grams are barriers to achieve health benefits. The aim of this study is to evaluate the effea of exercise on I} the type of InteTVentlon in mental health, 11) in salivary leveis of alpha-amylase and cortisol and serum leveis of 5100B and BDNF, and on 111) the quality of life and self­perception of the physical domain of people with schizophrenia. The sample consisted of 31 females in long-term institutions in the Casa de Saúde Rainha Santa Isabel, with age between 25 and 63, and with diag­nosis of schizophrenia according to the Diagnostic and Statistical Man­ual of Mental Disorders (DSM-IV-TR). Physical fitness was assessed by the six-minute walk distance test (6MWD). Biological variables were determined by EUSA (Enzyme-Linked Immunosorbent Assay). Psy­cholog ical variables were assessed using SF-36, PSPP-SCV, RSES and SWLS tests. Walking exercise has a positive impact on physical fitness (6MWD - p = O.OOl) and physical components of the psychological tests ([SF-36J physical functioning p < 0.05; [PSPP-SCVJ functionality p < 0.05 and SWLS p < 0.05 of people with schizophrenia. lhe walking pro­gram enhances the quality of life and self-perception of the physical domain and physical fltness of people with schizophrenia.

$3 Diagnosis and innovative treatments • the way to a better medicai practice Celeste A!ves 1.2

'CUF Hospitais, Lisbon, Portug2!; 2Sreast Unit, Champalimaud Clinicai Center, Lisbon, Portugal BMC Hea;th Services Research 2016, 16(Suppl 3};S3

( ) BioMed Central © 2016 The Author(s). Open Access This article is distributed vnde' the terms ofthe Creative Commons Attribution 4.0 International License (http-JIereativecommons.orgllicenses/by/4.0t), which permits unrestrieted use, distribution, and reproduction In any medium, provided you give appropriate credit to the original author(s) and the souree, provide a link lO

the Creative Commons license. and ind icate if changes were made. The Creative Cornrnons Pubilc Domaln DedlcatlOll walver (httpJ!creativecommons.orglpublicdomair1/zero/1.0t) applies to the data made avai lable in this artiele, unles5 otherwi5e 5tated.

BMe Heaith SeNices Research 2016, Volume 16 Suppl3

evaluate the postural changes among students of basic schools in the district of Porto. Melhods Weight and height were measured. The "body chart" and visual analogue scale for pain and static postural form for evaluation of postural changes, backpack characteristics and additional physical ac­tivity questionnaire were used. Results This study included 285 students, aged 11.46 years ± 1.32 years, and weighing 43.36 kg ± 10.49 kg and with a height of 1.48 m ± 0.95 m. Use of backpack: 97.5 % of the participants, 83.0 % use it in both shoulders and 17.0 % only on one shoulder. In relationshlp to phys­ical activity 58.0 % do It after regular school time, the most prevalent physical activity was swlmming wlth 21.3 % and 23.1 % for football. Pain lifetime prevalence was 43.0 %. With regard to postura I changes, elevation of the shoulders was the most prevalent (78.0 %), changes in iliocostalis angle (52.5 %) and flat feet (47.2 %1, calcaneus valgus (37.7 %) and scoliosis (25.5 %), anterior head projection (63.0 %), anterior shoulder (45.2 %), pelvic anteversion (37.7 %), lum­bar hyperlordosis (56.9 %) and knee recurvatum (24.2 %). Conclusions We condude that postural changes found are according the postural characteristics for this age group and identification of changes allowed earlier clinicai referral and propose school postura I education prevention programmes. Keywords Postura I changes, school children and adolescents, school health, backpack. paln

013 Ischemic stroke vs. haemorrhagic stroke survival rate Ana G. Figueiredo (ritagfigueiredo@gmail.com) , Escola Superior de Saúde Dr. Lopes Dias, Instituto Politécnico de Castelo Branco, 6000-767 Castelo Branco, Portugal BMC Health SelYices Research 2016, 16(SuppI3):013

Background Stroke Is the main cause of death in Portugal and it's also one of the pathologies involved ln several physical and psychological comorbid­ities and which often prevents stroke patients from havlng an au­tonomous life. There are still severa I gaps related to the prognosis of the two different types of stroke (ischemic and haemorrhagic) and is relevant to know which type has the better longevity. Objective: The main objective of the present study is to evaluate the survival rate of both types of stroke, and simultaneously the mortality risk in those patients. Methods A sample of 1367 individuais who suffered a stroke was collected in Hospital do Espírito Santo de IOvora, between 2010 and 2015, after that the sample's profile, risk factolS and associated comorbidities were studied. Then, we created a subgroup from the initial sample with 311 individuais who suffered both types of stroke in the period 2013-2014 and performed a statistical analysis of survival and mortal­ity risk. Results Individuais who suffered ischemic stroke have a lower mortality rate, as well as an improved initial survival; Three months after the event, the mortality risk becomes independent of the stroke type. We also observed that age has an effect on survival. Condusions Haemorrhagic stroke is associated with an increased mortality and worse survival rate compared with ischemic stroke. Keywords ischemic stroke, haemorrhagic stroke, survival, mortality

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014 Chronobiological factou as responslble for the appearance of locomotor pathology in adolescents Francisco J. Hernandez-Martinez' , Liliana Campi2

, M' Pino Quintana­Montesdeoca3, Juan F. Jimenez-Diar, Bienvenida C. Rodriguez-De-Vera3

'Cabildo de Lanzarote, 35500 Arrecife, Lanzarote, Las Palmas, Espana; 2Servicio Canario de la Salud, 35500 - Arrecife, Lanzarote, Las Palmas, Esparia; 3Universidad de Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, Las Palmas, Espana Correspondence: Francisco J. Hernandez-Martinez (fjhernandez@denf.ulpgc.es) - Cabildo de Lanzarote, 35500. Arrecife, Lanzarote, Las Palmas, Espana BMC Health Services Research 2016, 16(SuppI3):014

Background Chronobiology is a discipline that studies the biological processes fol­Iowing predictable temporal sequences, focusing on lhe analysis of cir­cadian rhythms and biological rhythms associated with the geophysical basis. Any physiological fundion of living things can be analysed from the perspedive of chronobiology as a phenomenon with a significant temporal and rhythmlc dlmension. Objective: To determine whether the existence of chronobiological factors and circadian variations In­volved in the development of loco motives diseases in adolescence. Methods Observational, descriptive, retrospective and quantitative study on the adolescent population of Lanzarote (Canary Islandsl from 2010 to 2015 Study. Data collection: computer system Drago. Statistical Ana­Iysis with SPSS 23.0 software. Results On a sample of 1,214 adolescents it was found a significant assoei­ation (p < 0.023) between gender, seasonal time and location of the lesion, being more frequent in males 11-16 years, most of them in autumn and winter and being the lower limbs in men (56 %) and arms in women (42 %), the most affected areas. Highlighting the lack of medicai records in medicai records regarding the etiology of the lesion (37.2 %) and time of occurrence (89 %). Conclusions The teenage gender is a trigger factor in musculoskeletal disorders. The prevalence of these diseases is higher in urban areas. The prevalent eti­ology is trauma. lhe climate and geographical location Df Lanzarote, slgnificantly influence the etiology and location Df the lesion. We should prepare educational programs on risk prevention at schools. Keywords Chronobiology, adolescence, Lanzarote, locomotor pathology

015 Rlsk of malnutrition ln the elderly of Bragança Alexandra Parente, M' Augusta Maca, Ana M' Pereira, Adília Femandes, Mant;el Brás Escola Superior de Saúde, Instituto Politécnico de Bragança, 5300-1 21 Bragança, Portugal Correspondence: Manuel Brás (rranuel-bras@ipb.pt) - Escola Superior de Saúde, Instituto Politécnico de Bragança, 5300-121 Bragança, Portugal BMC Health ServiCf?5 Research 2016, 16(Suppl 3):015

Background Malnutrition affects a significant number of people, the elderly being lhe main group affected. Retrospective studies highlight that the elderly are at higher risk and have higher susceptibility of nutrltlonal deficiencies than young adults. Objective: To assess the risk of mal­nutrition in the elderly of Bragança. Methods Analytical and cross-sectional study. Based on a sampling error under 5 % and a confidence levei of 95 %, a sample of 385 elderly people

BMe Health Serv;ces Research 2016, Volume 16 Suppl 3

stratified by gender and age was studied. A questionnaire was used including nutritional risk assessment uslng the Mini Nutritional As­sessment (MNA). Results 56.4 % (217) are women and 43.6 % (168) are men with an average of 76.39 ± 7.18 years of age. The majority (62.9 %; 242) is married/civil partnership and 28.6 % (110) are widowers. 37.8 % (134) relate some degree of loneliness. We also noticed that 96 elderly (24.9 %) show risk of malnutrition. Those who are married/in a civil partnership have higher probability of normal nutritional condition when com­pared with single or divorced (OR = 2.925); those with schooling have higher probability of normal nutritional condition (OR = 2.287) com­pared to those without schooling. The ones who mention less loneli­ness present 1.5 to 4.7 higher probabilities of normal nutritional condition compared with the ones who state any levei of loneliness. The ones who are functionally independent have higher probability of a normal nutritional state than those who have any degree of dependency. Conclusions Results highlight the need for specific protocols in health institutions to identify old people at nutritional risk allowing a timely intervention. Keywords Elderly, malnutrition, risk

016 A Llfestyle Educational Programme for primary care diabetic patients: the design of a complex nursing intervention Ma Rosário Pinto', Pedro parreira2, Marta L. Basto3, Ana C. Rei4,

Usete M. Mónico5

'Escola Superior de Saúde de Santarém, Santarém, 2005-075 Portugal; 2Escola Superior de Enfermagem de Coimbra, Coimbra, 3046-851 Portugal; 3Escola Superior de Enfermagem de Lisboa, Lisboa, 1,0D-063 Portugal; 4Hospital Distrital de Santarém, EPE, Santarém, 2005-1 77 Portugal; 5Universidade de Coimbra, 3004-504 Coimbra, Portugal Correspondence: Ma Rosário Pinto (mrosariopinto.essaude@gmail.com) - Escola Superior de Saúde de Santarém, Santarém, 2005-075 Portugal BMe Healrh Serv;ces Research 2016, 16(5uppI3):0 16

Background Therapeutic Education is structural to diabetic people's self-control. Although these questions have been a research theme of concem over the past years, there is a shortage of tested educational prO­grammes that allow discussion of its effectiveness. Objective: To de­sign a lifestyle educational programme for diabetic patients. Methods An exploratory and descriptive approach was made, starting by char­acterizing and understanding the context - a Primary Care Unit, as well as the usual educational intervention developed. Data collection included semi-directive interviews, observational moments and rec­ord analysis. Supported by a theoretical framework (Orem's Self-care Theory and Empowerment perspective), information was analysed and discussed with lhe nurses, in group and individual interactions, from July until October 2014. Results The result was a Lifestyle Educational Programme directed to people with type 2 diabetes, focused on lifestyle and self-control behaviours, to be implemented by primary care nurses. With a 24-week timeline, the programme starts with a face-to-face nursing intervention, followed by two educational group sessions, the first one focussed on self-motivation and lifestyle generic behaviours, and the second one centred on foot self-care and monitoring. At 12 weeks, the sec­ond face-to-face intervention is done, complemented by a telephone monitoring intervention after four weeks, ending with the last indi­viduai momen!, 24 weeks after the beginning of the programme. Conclusions The programme developed is a Complex Intervention, with several components, inciuding the intervention usually carried ou! by nurs­ing professionals, in addition to which is added group and telephone intervention, merged in an educational protocol that follows specific sequential phases.

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Keywords Therapeutic Education, Type 2 Diabetes, Lifestyle Educational Pro­gram, Nursing education

017 Medication adherence in elderly people Gilberta Sousa, Clementina Morna, Otrlia Freitas, Gregório Freitas, Ana Jardim, Rita Vasconcelos Universidade da Madeira, 9000-082 Funchal, Portugal Correspondence: Giiberta Sousa (gfranca@uma.pt) - Universidade da Madei ra, 9000-082 Funchal, Portugal BMC Healrh Services Research 2016, 16(SuppI3):OI7

Background Adherence to medication regimens is an indicator of health service efficiency (WHO, 2003). It promotes improvements in clinicai status, safety and quality of life of individuais and leads to better financiai results, reflected by reduced use of health services and decreases the risk of aggravation of disease and acute crises caused by inadequate drug management. Objective: Descrlbe the levei and factors associ­ated with the adherence to medication regimens in the elderly. Methods From a research-action perspective, we developed a descriptive, quantitative and transversal study (2014), with random and acciden­tal sample in a Madeira Island parish (n = 493) using the question­naire "Measure Adherence to Treatment- MAT" validated for the Portuguese population (a = 0.74). Results Mean age 70 years (a ± 7.1); 68 % female; 70 % have 4 years of edu­cation; 40 % consume 5 ar more different drugs/day; with a mean of adherence of 5.4(6). The ma in factors that influence adherence are the problems of memory (40 %); In the MAT subscales 23.5 % non­adherence was found; 13.5 % non-adherence by excess; 18.0 %-non­adherence by deficit and 14.1 % other causes. In the subscale of non-adherence, the values observed were: 33.0 % failure to take the medication; 30.5 % the neglect in the time of taking; 16.8 % abandon­ment beca use they feel better and 15,8 % because they feel worse. Conc1usions The results corroborate the findings of other studies and express the priorities for action in this contexto In partnership, specific objectives were outlined and nursing interventions designed to enhance pa­tient adherence to medication prescriptions.

Acknowledgements Authors wish to acknawledge the helpful collaboratian given to this study by lhe Nursing students.

Keywords Adherence to medication regimen, elderly, nursing intervention

018 Hospitalization for cervical cancer of residents in the metropolitan region of Porto Alegre, Southern Brazil, 2012 to 2014 Una G. Horta, Roger S. Rosa, Lufs F. Kranz, Rita C. Nugem, Mariana S. Siqueira, Ronaldo Bordin Federal University of Rio Grande do Sul, Porto Aiegre, Rio Grande do Sul, 90050-170, Brasil Correspondence: Roger S. Rosa (rogerJosa@ufrg s.br) - Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, 90050-170, Brasil BMC Healrh Services Research 2016, 16(Suppl 3):018

Background Cervical cancer is caused by persistent infection due to certa in onco­genic types of human papillomavirus (HPV). These changes of the cells are easily discovered on the Pap test and are curable in almost ali cases. Objective: To describe the characteristics of hospitalizations for cervical cancer in the public health system by residents of the Greater Porto Alegre (GPA), in southem Brazil, 2012 to 2014.